Premature loss of primary anterior teeth and its consequences to primary dental arch and speech pattern: A systematic review and meta-analysis.

BACKGROUND: Information about the functional and morphological consequences that occur following the premature loss of anterior teeth is still insufficient. AIM: To evaluate the consequences in children's speech and arch integrity following premature loss of primary anterior teeth compared to those without premature losses. DESIGN: Electronic searches were performed based on the PECO criteria. Observational studies in children (P) who suffered premature loss or extraction of primary anterior teeth (E) compared to children presenting normal occlusion development (C) and the consequences to speech and dental arch perimeter (O) were included. Risk of bias and data extraction were performed. The meta-analysis evaluated the influence of premature loss of primary anterior teeth in articulatory speech disorders (distortion, omission, and substitution) and space loss in the dental arches. Random- and fixed-effect models were used, and heterogeneity was tested. The certainty of evidence was estimated using the GRADE approach. RESULTS: From a total of 2.234 studies, six studies were included in the qualitative synthesis, and four in speech disorders meta-analysis. Despite it was not possible to perform space loss meta-analysis due to the absence of available data, qualitative analysis showed that there was no space loss after premature loss of mandibular primary incisors; a space loss, however, could be observed in children who lost primary canines at an early stage of dental development. For speech disorders results, children who lost anterior tooth presented higher chance of suffering speech distortion, than children without tooth loss (OR 5.466 [1.689, 17.692] P = .005) with low certainty of evidence. On the other hand, there were no statistically differences between premature loss of primary anterior teeth and omission (OR (a) 1.157 [0.439, 3.049] P = .767 and (OR (b) 1.393 [0.434, 4.70] P = .577) or substitution (OR (a) 1.071 [0.581, 1.974] P = .827 and OR (b) 1.218 [0.686, 2.163] P = .5), both with very low certainty of evidence. CONCLUSIONS: Premature loss of primary anterior teeth may affect children phonation causing speech distortion. Consequences of space loss to primary dental arch still need to be further studied. Despite the speech distortion results, included articles present low-level evidence-based quality, thus new studies should be performed.

A Survival Analysis of Different Pulp Therapies in Decayed Primary Teeth

Abstract Objective: To identify the clinical and radiographic conditions associated with failure of pulp therapy in primary teeth through a survival analysis. Material and Methods: A total of 1000 records of children assisted at the pediatric dentistry clinic of the Federal University of Parana, Brazil, from the years 2000 to 2010, were analyzed. The mean evaluation time was 10.61 months (minimum/maximum: 1/28) from the report of pulp therapy. The different types of treatments analyzed included indirect pulp treatment (IPT), direct pulp treatment (DPT), pulpotomy and pulpectomy. The Kaplan-Meyer method and log-rank test were used for the survival analysis. Exodontia was considered as the outcome variable and censors included: traumatic tooth loss, presence of the tooth in the oral cavity and physiologic tooth exfoliation. Results: A total of 122 records reporting pulp therapy in the primary teeth were selected. From this, 16 teeth (13.12%) were extracted. Survival analysis showed that pulpectomy presented lower survival rates when compared to conservative therapies (p=0.0297). Teeth with furcal lesions and pathological root resorption before pulp therapy had lower survival rates when compared to those that did not present these conditions (P=0.006). Presence of fistula and abscess after pulp therapy were also associated with lower survival rates (P=0.0062 and 0.0143, respectively). Conclusion: Signals of pulp necrosis were associated to lower survival rates in primary teeth submitted to pulp therapy.

Biocompatibility and biomineralization ability of Bio-C Pulpecto. A histological and immunohistochemical study.

AIM: To evaluate the inflammatory response, biomineralization and production of osteocalcin (OCN), osteopontin (OPN), and bone sialoprotein (BSP) of a new root filling material for primary teeth (Bio-C Pulpecto) compared to MTA. DESIGN: Polyethylene tubes containing Bio-C Pulpecto, MTA, and empty tubes were implanted into the dorsal connective tissue. After 7, 15, 30, 60, and 90 days, the tubes with surrounding tissue were removed and histologically processed to be analysed using haematoxylin and eosin, von Kossa staining, or no staining for observation under polarized light and immunohistochemistry for the detection of OCN, OPN, and BSP. The Kruskal-Wallis test was used followed by Dunn's test. The significance level was set at 5%. RESULTS: The inflammatory response observed with MTA and Bio-C Pulpecto was more exacerbated until the 15th day and decreased from 30 days on. No significant difference was found between control, MTA, and Bio-C Pulpecto (P > 0.05). Bio-C Pulpecto and MTA showed positivity for von Kossa and birefringent to polarized light. The immunolabelling for OCN, OPN, and BSP was more intense for MTA and Bio-C Pulpecto on days 60 and 90 (P > 0.05). CONCLUSION: Bio-C Pulpecto was biocompatible, induced biomineralization and was immunopositive for osteogenic markers such as OCN, OPN, and BSP, similarly to MTA.

Utilização de restaurações indiretas na reabilitação de dentes decíduos anquilosados / Utilization of indirect restorations in rehabilitation of ankylosed deciduous teeth

A anquilose consiste na fusão anatômica do cemento dentário com o osso alveolar, situação que provoca a infra-oclusão do elemento dentário, evento comumente encontrado em molares decíduos e que pode causar prejuízo no desenvolvimento da oclusão. Na clínica odontopediátrica o diagnóstico precoce se torna fundamental, posto que dependendo do grau de severidade serão adotadas condutas diferentes para o tratamento. As restaurações indiretas em resina composta são indicadas como opção clinica no manejo desta situação, proporcionando a reabilitação funcional e oclusal. Este trabalho tem como objetivo relatar um caso de um paciente infantil do sexo feminino com sete anos de idade, no qual os primeiros molares decíduos inferiores encontravam-se em infra-oclusão de grau leve. O tratamento escolhido foi a reabilitação por meio de restaurações indiretas em resina composta, posto que se constitui de uma técnica de fácil execução e baixo custo. O exame radiográfico de controle após seis meses mostrou a reabsorção fisiológica de ambos os elementos dentários, demonstrando o sucesso do procedimento.

Ankylosis is the anatomical fusion of cementum with alveolar bone, a situation that causes tooth infra-occlusion, an event commonly found in primary molars and that can cause damage in the occlusion development. Early diagnosis in pediatric dentistry is fundamental, because depending on the severity degree different approaches for treatment will be adopted. Indirect restorations with composite resins are indicated as a clinical option to managing this situation, providing functional and occlusal rehabilitation. The aim of this work was to report the case of a female child patient, seven years old, whose first lower deciduous molars were in mild infraocclusion. The treatment selected was rehabilitation with indirect restorations with composite resins, because it is a simple technique with low cost. The control x-ray examination after six months showed the physiological root resorption of both teeth, demonstrating the success of the procedure.